Shaare Zedek’s president reviews challenges in COVID-19 care – and what lies ahead.

THE HIGHEST standards of personal protective equipment were required for all corona patient interactions

(photo credit: TAL CHERES)

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With more than four decades of medical experience, including 31 years as director general of Shaare Zedek Medical Center, Jerusalem, Prof. Jonathan Halevy has seen almost every challenge a public healthcare expert could imagine: wars, terrorism waves, financial crises and infectious disease outbreaks.

Today, Halevy is president of Shaare Zedek and is involved with the hospital’s daily operations while also overseeing resource development and external affairs.

Describing the hospital’s activities since early March he says, “There is simply no precedent.”

Since Shaare Zedek absorbed its first Corona patient, over 400 other cases have followed, making the hospital the most active medical center for COVID-19 response in the Jerusalem area and the second-busiest in all of Israel.

Beyond the intense rate of activity, Halevy says that among the biggest challenges with this medical response are the unknowns. “This situation is defined by uncertainty, as we really still don’t understand this virus. This means that we need to approach clinical care extremely carefully, while isolating patients and outfitting our staff with protective equipment. All of this combines for a truly unprecedented medical response.”

At the height of the crisis – which came over Passover – the hospital was treating over 120 patients in five separate units and in a dedicated Intensive Care Unit.

While he admits the situation was extremely challenging for the staff from both practical and emotional perspectives, Halevy says Shaare Zedek entered the crisis with a very high level of preparedness. He credits Prof. Ofer Merin, the hospital’s director general for establishing an infrastructure – both physical and medical – that was best positioned to confront all types of potential scenarios. Merin, who also heads the IDF’s mobile field hospital operations and disaster response efforts in many parts of the world, had previously run simulations for biological disease outbreaks upon which Shaare Zedek was able to rely.

“Every increase in patient numbers was anticipated prior to the fact, which enabled us to provide the best possible care when each wave of patients arrived.”

Since that peak in early April, there has been a steady decline in cases, both in Shaare Zedek and across Israel.

Halevy points out that there were numerous cases where seriously ill patients were successfully weaned off respirators and ECMO heart lung machines following a prolonged period of life-support.

“Medicine is not magic, and we aren’t magicians, but our success is a combination of presenting the appropriate levels of professional treatment and carefully measuring how the patient has been affected by the disease and their immune system’s ability to respond.”

The hospital further instituted numerous measures to address the emotional needs of family members, including a Family Liaison Unit staffed by social workers and a tele-medicine network enabling isolated patients to be in contact with the outside world.

Overall, Halevy says that Israel has fared better than many other countries internationally. He ascribes Israel’s overall success to the early closure of its borders from countries in the Far East.

In addition, he suggests that the Health Ministry’s warning at the beginning of the crisis that disobeying the government’s directives could cause increased mortality led to increased discipline among the population.

“You can compare us with Sweden, that employed a controversial approach to isolate just the elderly, without any other limitations. We have a population of over nine million and Sweden has over 10 million and they have more than ten times the numbers of fatalities.”

Halevy explains that relaxing the restrictions is an issue of measuring risk.

“The economy has been greatly affected, and I fully understand that addressing that aspect of the crisis has to be part of our response. The government has no choice but to balance between the contagiousness of the epidemic and our desire to eradicate the virus, while never ignoring the major damage to the economy. They understood this early on and banned large gatherings.”

Looking to the future, he says, “If people remain disciplined by wearing masks, keeping two meters apart, and employing hand-hygiene, we can significantly reduce the chances for a second wave.”

Cautioning that discovering and delivering a working vaccine is at least a year away, he predicts that social distancing will likely remain a part of our lives for months to come.

Observing an aspect of the crisis that has the potential for long-term damage, he laments the fact that many individuals stayed away from hospitals for fear of becoming infected.

“People were afraid, and we will pay a price when services return to a more normal pace. Arterial blockages will be discovered later than desired, and we will see increased rates of congestive heart failure and shortened life expectancies. It’s the same with strokes. So, people need to understand that they should never push off coming when there is a need. We have intentionally and carefully isolated the corona wards to make the hospital safe for all our patients.”

Beyond the immediate physical effects of the crisis, Halevy stresses that its psychological effects will have a long-lasting impact on the mental health of the population. The daily reports of illness and death, as well as lockdowns, have placed great stress on society.

“Stress of this magnitude affects the body,” he says, and it will undoubtedly manifest itself in different illnesses and ailments.

AT THE of the crisis, the hospital was treating over 120 patients in five separate units and in a dedicated intensive care unit. (Credit: Tal Cheres)

AT THE of the crisis, the hospital was treating over 120 patients in five separate units and in a dedicated intensive care unit. (Credit: Tal Cheres)

Given Shaare Zedek’s significant experience with addressing the virus, the hospital is employing its extensive research capabilities to better understand the disease and potential treatments. Recently, Shaare Zedek and the Israel Institute for Biological Research embarked on a collaborative effort to detect the coronavirus by exhalation sampling from patients. If researchers are successful in identifying the unique markers for corona, this could lead to the development of a coronavirus test that would provide results in a matter of minutes, which would greatly help efforts to test large numbers of the population for the virus.

While admitting that many aspects of COVID-19 remain a mystery, Halevy believes that the scientific community and public health administrators have learned a great deal about how to respond.

“There is no doubt that we will be better prepared for the next wave or future pandemics,” he says. “What we’ve seen in Italy, Spain, New York and the UK are scenes that we need to make sure we never experience again and that is what the medical community will be focused on in the period ahead.”

The economic toll of the crisis has been particularly problematic for the healthcare industry, which has had to invest massive resources in its response while postponing many procedures that provide much-needed income. Shaare Zedek has already assigned more than NIS 25 million to its Corona response program – funds that the hospital’s projected budget for 2020 did not include.

Halevy says that he has been extremely moved by the generosity of donors of all sizes who have come out in support of the hospital since the outbreak of the crisis.

“We still don’t know what the future will bring, but the response we have seen to date has been extraordinary.”

Echoing a theme heard all over the world, Halevy says that the people who deserve to be saluted most during this time have been the medical teams and support staff.

“Not only are the doctors heroes, but so too are the hospital cleaners, the social workers who try to ease the situation for patients and families, and countless other staff members.”

Describing himself as a natural optimist, Halevy believes that there are positives that can be gleaned from this crisis.

“Even while this has been an incredibly costly and painful time for our city, country and indeed our world, I think we all also deserve to take great pride in what we as a community have been able to accomplish. We must learn from this experience to ensure we are that much better prepared for whatever lies ahead.”

This article was written in cooperation with Shaare Zedek Medical Center.

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